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In the Spotlight: Chenue Abongwa, M.D.

Chenue Abongwa, M.D., joined CHOC Children’s in October 2018 as a pediatric neuro-oncologist at the Hyundai Cancer Institute. After finishing medical school at the Universite de Yaounde in Cameroon, he completed his pediatrics residency at Brookdale University Hospital in New York, his pediatric hematology/oncology fellowship at University of Iowa Hospitals and his neuro-oncology fellowship at Children’s Hospital of Los Angeles. We chatted with him about his time at CHOC so far.

Dr. Chenue Abongwa, Pediatric Neuro-Oncology

What drew you to medicine? Pediatrics specifically?

I was drawn to medicine earlier in my childhood. My mother worked as a nurse, and I often accompanied her when she did house calls to visit children and was very impressed by her dedication and desire to help sick children. I wanted to be like her when I grew up.

What about CHOC stuck out to you?

I initially heard about CHOC in 2013 when I was a fellow in pediatric hematology/oncology and came across a well-written web guideline on febrile neutropenia. This prompted me to seek information about the institution and about the team. I was very impressed by the institutional vision, dynamism, patient-centeredness and search for excellence. I applied without hesitation when the opportunity came.

Are you or do you plan to be involved with any special projects or groups at CHOC?

I am currently involved in several divisional clinical projects based on COG (Children’s Oncology Group) and will be joining some committees.

Can you share some of your goals at CHOC?

My goals are to initially build a strong clinical base by working in the neuro-oncology team in the short term. I hope in the long term to be actively involved in quality improvement, research and teaching.

What do you want your patients and their families to know about CHOC? 

The diagnosis of cancer in a child is a very difficult and traumatic experience to children and their families. Being part of their lives in these extremely difficult periods and advocating for these families is a great privilege. Our team here at CHOC, with its focus on patient-centered care, is the right place for these families to be during this time.

What do you like to do outside of CHOC?

I love traveling, watching football and playing chess.

CHOC team using new device to close heart defect in tiny patients

Tiny premature babies who suffer from a common but potentially fatal opening in their hearts are now being treated with a new device by physicians at CHOC Children’s.

The team successfully completed the first procedures March 20 and 21 to close a patent ductus arteriosus (PDA), an opening between two blood vessels of the heart that has failed to close on its own. CHOC became one of the first hospitals to use the Abbott Amplatzer Piccolo™ Occluder since it was approved by the FDA in January.

The Abbott Amplatzer Piccolo™ Occluder is about the size of a pea.

“We’ve never had the capability of doing this here at CHOC,” says Dr. Amir Ashrafi, director of CHOC’s neonatal-cardiac intensive care. “While closing a duct in a catheterization lab is not a new technology, closing a duct in a cath lab in very small babies is a big deal. The fact that we are now going to be one of the centers that are doing this, that is a big deal.”

PDAs are among the most common heart defects in premature babies. The opening, also called a duct or channel, is present in all fetuses and plays a vital role in allowing oxygen-rich blood from the mother to circulate through the unborn child’s body. In most cases, it closes spontaneously after birth. But out of the 60,000 infants born prematurely each year, 1 in 5 (12,000) has a PDA severe enough to require urgent medical attention.

“What happens is that blood goes in the wrong direction, so instead of blood going to the body, it goes into the lungs, so now the lungs get flooded,” Ashrafi says.

Without treatment, a PDA can cause breathing difficulty and a variety of other problems.

“It affects their feeding, because they’re having such a hard time breathing,” says Dr. Gira Morchi, an interventional pediatric cardiologist at CHOC. “It’s a cascade effect. It can affect the GI tract, kidneys, and the brain.  Taking away the extra workload on the body allows for recovery.”

Abbott had previously developed the Amplatzer™ Duct Occluder to treat the same problem in larger pediatric patients. The new, smaller, device – measuring 3 mm by 2 mm – can be used in patients as young as 3 days old and weighing as little as 1.5 pounds, or 700 grams.

The procedure is performed through cardiac catheterization via a small incision made in the baby’s leg, near the groin area, to access a vein leading to the heart. A catheter is inserted, with the device inside. It’s the size of a small pea, and made of tightly woven metal mesh. Cameras and ultrasound guide the operator – in this case, Morchi – “correctly position the device” in the heart, she says. The device is deployed and placed in the opening, where it expands on its own. The device stays in the body, with tissue healing around it.

A cardiac catheterization lab at CHOC Children’s Hospital

The first patient was a girl from Fullerton, Calif., who was born at 28 weeks and weighed 1.1 kilograms. The second patient, a girl from Huntington Beach, was born at 25 weeks and weighed 800 grams. The procedures were conducted when the babies were 2.5kg and 2.4 kg, respectively. The device is approved for much smaller infants than those, but the CHOC team is being selective about its cases.

“We’ll just slowly work our way down,” Ashrafi says. 

Morchi herself has been doing such catheterizations for a decade. “We’re very comfortable with actually doing the procedure, so the real art here is to keep the babies stable while this procedure is happening,” she says. Conditions in the cath lab should closely match those in the NICU, including keeping the temperature warm. “We crank the heat up.”

Start to finish, the baby is in the room for 90 minutes to 2 hours, but the actual procedure only takes 20-30 minutes, she said.

Besides Morchi, the interventional cardiology team also included Dr. Sanjay Sinha and Dr. Mitch Recto.

A closer look at the Abbott Amplatzer Piccolo™ Occluder

The achievement was the result of a 2-year collaboration between CHOC and UC Irvine. Credit also goes to Dr. Evan Zahn of Cedars Sinai Medical Center in Los Angeles, who was an early adopter of the procedure and was lead investigator in the FDA approval study for the Abbott device. The trial included 50 patients at eight facilities in the U.S.

Upon FDA approval of this device, Abbot Vascular recognized CHOC Children’s as one of the first hospitals in America to use this device for those smallest and most vulnerable patients in the hospital. 

“This device offers a new era in treating PDAs, and was successful at CHOC in great part due to a strong effort of collaboration between the cardiologist and the neonatologists,” says Dr. Sinha, a CHOC/UCI pediatric cardiologist.

A day in the life of a mental health nurse

The CHOC Children’s Mental Health Inpatient Center is an inpatient psychiatric center exclusively dedicated to the treatment of children ages 3-17 with mental illness who are in immediate risk of hurting themselves or others. It is the only inpatient facility in Orange County that can treat patients younger than 12. Our doctors and care team are all specially trained to treat children and provide the very best patient- and family-centered care 24 hours a day, seven days a week.

During a child’s stay, he or she engages in daily multidisciplinary therapeutic groups and receives individual therapy, family therapy, brief psychological testing and psychiatric care.

In observance of Mental Health Month, follow along for a day in the life of Madeline, a clinical nurse in CHOC’s Mental Health Inpatient Center.

5:15 a.m. – After fighting my snooze button, I wake up, shower, and drink some much-needed coffee.

6:30 a.m. – My cat yells his goodbyes to me as I give him a treat and leave for work. On the way, I vibe out to music to get pumped up for the day. I’ve worked at CHOC for over a year now. Last year, I was accepted into CHOC’s Registered Nurse Residency program. As a new nurse, I felt called to work in a mental health setting. I am beyond proud to stand alongside the brilliant CHOC team on the frontlines of mental healthcare.  

7:00 a.m. – I join my team in our conference room for a daily briefing report. Together, we review any newly admitted patients, our current population of patients, and any safety concerns. One of the ways we keep kids safe is through trauma-informed care. Upon admission, we work with patients and their families to determine any triggering situations or actions the patients may have, and then learn how strong emotions may manifest outwardly; such as pacing, shaking, or becoming very quiet. This information helps us to rapidly identify when patients are struggling and may need extra support or encouragement to utilize their coping skills. One of my favorite environmental adaptations we can provide for patients is our sensory room. It helps stimulate a few of our five senses to help kids cope and be more present in the moment. Sometimes, just hearing the rhythmic movements of the bubbles can be soothing and have a great calming effect.

7:30 a.m. – Once I have an understanding of our environment, I walk the unit to check on the patients. Most are still asleep, so I then look up my patient’s medications, while verifying medication consents. All pediatric psychiatric medications need parental consent obtained by the patient’s psychiatrist.

8:15 a.m. — Our medication room has a barn door, so I can efficiently and safely administer patients’ morning medications, preform a quick mental status check-in, and obtain vitals.

9:30 a.m. — One of my patients is currently taking a new medication. In order to better understand her body’s acceptance and tolerance of the drug, we need to run labs. Before drawing her blood, I numb a small area of her skin using a J-Tip®. During the blood draw, a child life specialist and I help the patient cope by offering her modeling clay and a hide-and-seek activity book.

10:00 a.m. — Throughout the day, our patients are divided into groups based on age to attend group sessions. This creates a structured environment that promotes the development of coping and social skills they can utilize when they go home. The sessions focus on our various themes of the day that can range from problem solving or emotional regulation to nutrition and wellness. These sessions are led by our team of nurses, social workers, child life specialists, plus art and music therapists. This morning’s group session is focused on gross motor skills. Our group leaders soak up some sunshine in our beautiful outdoor area while supervising patients socializing and joining in on a game of handball.

11:00 a.m. — I sit down with one of my patients to discuss their day so far and check in on any thoughts of self-harm that we can work through together. Afterwards, as part of the patient care team, I meet with that patient’s psychiatrist Dr. Lavanya Wusirika, and social worker Gaby, to discuss the patient’s care plan.

12:30 p.m. – It’s time for the patients to have lunch. Our patients eat together, so I assist with passing out lunch trays and pouring drinks. One of our licensed vocational nurses, Brenda, has become our unofficial DJ, and she plays music during lunch to help create a fun, therapeutic environment.

1:00 p.m. – I receive a call from a patient’s parent. After addressing their questions, I update them on their child’s plan of care, medications and current temperament.

2:00 p.m. – I use my own lunch break to catch up with my coworkers. We spend a lot of time together, and I’m lucky to have such an amazing work family.

3:00 p.m. – It’s time for one of our patients to head home. Upon admission to the unit, our team begins organizing outside resources and planning ways to increase safety and support at home. This information is built upon throughout their stay and is incorporated into an individualized safety and coping plan. After our social workers discuss the plan for home with the patient and their parent, I review current medication information and additional discharge instructions. Staff members and fellow patients send off their peer with warm wishes and words of encouragement.

4:30 p.m. –As a nurse, it’s my turn to lead one of our nursing groups. After the patients participate in a discussion about favorite coping skills and we do a check-in of their current emotions, we follow a painting tutorial to practice our theme of the day, mindfulness.

6:00 p.m. – I spend time updating my patients’ charts, including their mental status assessments and treatment plans. This way our whole team can see the patient’s progress and any concerns.

6:45 p.m. – During daily community meetings, all of our patients join together, and our staff leads a check-in to summarize what has been learned from our theme of the day. Patients take turns sharing their high and low of the day and how we can build on these experiences for tomorrow.

7:00 p.m. – As our night shift nurses arrive, we take turns giving a report of their patient’s day and mental status. We share new triggers that we have learned from the patients as well as new coping skills that were helpful. Knowing how we can best care for patients before, during and after a crisis or stressful situation is fundamental for trauma-informed care. By caring for every patient as a whole, not as a diagnosis or as someone defined by their trauma or maladaptive behaviors, we are able to better understand and care for them.

8:00 p.m. ― Get home and share a delicious meal with my husband. A long hug and many kisses are bestowed unto my cat Boots. The three of us will cuddle up and watch a show before we head to sleep and start again.

Meet CHOC’s new pediatric residents

The CHOC Children’s Pediatric Residency Program is designed to provide residents a top-notch, broad-based educational experience in a collegial environment.

CHOC welcomes its 2019 UCI/CHOC Children’s matches:

Nichole Adiletta
Marielle Beamesderfer
Jacquelyn Benner
Maddie Berra
Juliana Biro
Natalia Calderon
Stanford Chun
Tabitha D’souza
Karina Espinoza Ardiles
Megan Goss
Amogh Kambalyal
Amber Kazi
Nicole Kelly
Iris Kim
Adam Lee
Joanne Liang
Alice Lin
Gwen Lin
Harrison Lowder
Sunit Misra
Dart Newby
Brenda Pelayo
Luke Peters
Casey Schreiber
Stephanie Walker
Kristin Yasuda
Allen Yiu
Divya Gupta, Child Neurology
Maggie Schweig, Child Neurology

In the Spotlight: Laura Lai, M.D.

Dr. Laura Lai joined CHOC Children’s in November 2018 as the psychiatry lead for the ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program (IOP) at CHOC. She also oversees the transition clinic for patients after discharge from the Mental Health Inpatient Center, and she is involved in the BAN (Bulimia Anorexia Nervosa) eating disorder clinic. She completed undergraduate and medical school at Texas A&M and her psychiatry residency and child and adolescent psychiatry fellowship at UC Irvine. We chatted with Dr. Lai about her journey in psychiatry and what she enjoys most about working with CHOC patients and families.

Dr. Laura Lai, psychiatry
Dr. Laura Lai, psychiatry

What drew you to psychiatry?

I was drawn to psychiatry because everyone has a story, and I loved hearing patients’ stories and finding ways to help them. And I saw patients who were suffering get better and live fulfilling lives. There is still so much we don’t know about mental health, and I find it exciting that we’re at a point in time when there is such a push to learn more and to develop new and innovative treatments. Just because mental illness isn’t always visible in a physical way doesn’t mean that it’s something that should be swept under the rug. I love that we’re talking about mental illness more and more because that’s the only way we’re going to fight the stigma.

What do you enjoy about pediatric psychiatry specifically?

Kids and teens go through so many different fun, exciting and sometimes scary life stages and it’s such a blessing to be able to help them navigate those times together. I love watching my patients grow and mature and develop new skills and experiences.

What about ASPIRE are you most proud of?

I am so proud of the entire ASPIRE team. Each and every team member is so capable and caring to patients, families and each other. I think that’s what really makes our program stand out. And we know that what we do works because we see so many patients and families progress as they go through the program. We’re often just a chapter in their overall mental health story, but for many, this time is a valuable turning point in their lives.

What would you most like the community or referring providers to know about your division at CHOC?

We’re growing, and we need your help, too. Many times, it’s not us but primary care doctors who are at the frontlines — the first to notice concerning signs and symptoms and raise those important questions way before the word “psychiatry” ever comes up. Thank you for all that you do, and please continue inquiring and talking about mental health. Learn more about the ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program (IOP) at CHOC Children’s.